ETHTE #: 13 -5 -30764
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Jason Ram Phone #: 910- 429 -4048
Address: 95 Palmer Walker Rd. Broadway, NC 27505
Name of Mobile Home Park or S /D: ERC II lot 3
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): Bella Bridge
Purpose of Inspection: replace home
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Section. At the time of inspection, there appeared to be a septic
system serving this site. If the system should malfunction, the owner is responsible for any
necessary repairs.
THIS INSPECTION IS VOID IF:
1. the intended use of the septic system should change, and/or
2. the system should fail or malfunction, and /or
3. the owner or tenant of the property change, and /or
4. after six months
1 f 1 1. LTA M01 • A,. 1,
0
AUTHORIZATION OF EXISTING SYSTEM
of nvironmental Health Specialist
-r'/ z C"i?
Date